Center for Gerontology and Healthcare Research, Brown University, Providence, Rhode Island.
Veteran Affairs Medical Center, Providence, Rhode Island.
J Am Geriatr Soc. 2018 Jul;66(6):1108-1114. doi: 10.1111/jgs.15334. Epub 2018 Apr 3.
To examine the effect of obesity (body mass index (BMI)≥30.0 kg/m ) on outcomes of older adults admitted to skilled nursing facilities (SNFs) for hip fracture postacute care (PAC).
Retrospective cohort study.
U.S. Medicare- and Medicaid-certified SNFs from 2008 to 2015.
Medicare fee-for-service beneficiaries discharged to a SNF after hospitalization for hip fracture (N=586,683; n=82,768 (14.1%) meeting obesity criteria). Exclusion criteria were aged younger than 65, being underweight (BMI<18.5 kg/m ), and SNF use in the year prior to index hospitalization.
Residents were divided into 4 BMI categories according to cutoffs that the World Health Organization has established: not obese (BMI 18.5-29.9 kg/m ), mild obesity (BMI 30.0-34.9 kg/m ), moderate obesity (BMI 35.0-39.9 kg/m ), and severe obesity (BMI≥40.0 kg/m ). Robust Poisson regression was used to compare differences in average nursing facility length of stay (LOS) and rates of 30-day hospital readmission, successful discharge to community, and becoming a long-stay resident (LOS>100) according to obesity level. Models were adjusted for individual-level covariates and facility fixed effects.
Residents with mild (adjusted relative risk (aRR)=1.16, 95% CI=1.12-1.19), moderate (aRR=1.27, 95% CI=1.20-1.35), and severe (aRR=1.67, 95% CI=1.54-1.82) obesity were more likely to be readmitted within 30 days than those who were not obese. The average difference in LOS between residents without obesity and those with mild obesity was 2.6 days (95% CI=2.2-2.9 days); moderate obesity, 4.2 days (95% CI=3.7-5.1 days); and severe obesity, 7.0 days (95% CI=5.9-8.2 days). Residents with obesity were less likely to be successfully discharged and more likely to become long-stay nursing home residents.
Obesity was associated with worse outcomes in postacute SNF residents with hip fracture. Efforts to provide targeted care to residents with obesity may be essential to improve outcomes. Obesity may be an overlooked risk adjuster in quality-of-care measures and in payment reforms related to PAC for individuals with hip fracture.
研究肥胖（体重指数（BMI）≥30.0 kg/m ）对接受髋部骨折术后康复护理（PAC）的老年熟练护理设施（SNF）入住患者结局的影响。
回顾性队列研究。
2008 年至 2015 年美国医疗保险和医疗补助认证的 SNF。
医疗保险按服务付费受益人在因髋部骨折住院后出院至 SNF（N=586683；n=82768（14.1%）符合肥胖标准）。排除标准为年龄小于 65 岁、体重不足（BMI<18.5 kg/m ）和在指数住院前一年使用 SNF。
根据世界卫生组织（WHO）设定的截止值，居民被分为 4 个 BMI 类别：非肥胖（BMI 18.5-29.9 kg/m ）、轻度肥胖（BMI 30.0-34.9 kg/m ）、中度肥胖（BMI 35.0-39.9 kg/m ）和重度肥胖（BMI≥40.0 kg/m ）。使用稳健泊松回归比较根据肥胖水平的平均护理设施住院时间（LOS）差异和 30 天内医院再入院率、成功出院至社区和成为长期居民（LOS>100）的比率。模型调整了个体水平的协变量和设施固定效应。
与非肥胖者相比，轻度（调整后相对风险（aRR）=1.16，95%置信区间（CI）=1.12-1.19）、中度（aRR=1.27，95%CI=1.20-1.35）和重度（aRR=1.67，95%CI=1.54-1.82）肥胖患者在 30 天内再入院的可能性更高。非肥胖居民与轻度肥胖居民之间的 LOS 平均差异为 2.6 天（95%CI=2.2-2.9 天）；中度肥胖，4.2 天（95%CI=3.7-5.1 天）；严重肥胖，7.0 天（95%CI=5.9-8.2 天）。肥胖患者成功出院的可能性较低，成为长期疗养院居民的可能性较高。
肥胖与髋部骨折后急性 SNF 居民的不良结局相关。为肥胖居民提供有针对性的护理可能是改善结局的关键。肥胖可能是髋部骨折患者 PAC 相关质量护理措施和支付改革中被忽视的风险调整因素。
